Provider Demographics
NPI:1578685111
Name:NEW YORK DIALYSIS SERVICES, INC.
Entity Type:Organization
Organization Name:NEW YORK DIALYSIS SERVICES, INC.
Other - Org Name:FMS-ATLANTIC HEMODIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:595 DEGRAW ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3120
Mailing Address - Country:US
Mailing Address - Phone:718-852-6672
Mailing Address - Fax:718-852-6440
Practice Address - Street 1:595 DEGRAW ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3120
Practice Address - Country:US
Practice Address - Phone:718-852-6672
Practice Address - Fax:718-852-6440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01855889Medicaid
332577Medicare Oscar/Certification